Chronic total occlusion percutaneous coronary intervention: managing perforation complications

Francesco Moroni, Emmanouil S. Brilakis, Lorenzo Azzalini

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Coronary artery perforation (CAP) is an infrequent (<1%) complication of percutaneous coronary intervention (PCI), that can lead to dramatic consequences, including tamponade and death. The incidence of CAP is higher (4–9%) in chronic total occlusion (CTO) PCI due higher complexity of these lesions and the techniques used to recanalized them. Areas covered: In this Expert Review, we discuss the specific features of CTO PCI predisposing to CAP. We also describe the typical procedural scenarios in which CAP can occur and provide a universal management algorithm. Currently available devices and techniques for CAP treatment are presented in detail. Finally, we discuss imaging support for diagnosis of pericardial effusion in CAP as well as medical and surgical management. Expert Opinion: With increasing volumes and complexity of CTO PCI, the incidence of CAP is likely to rise. Adherence to good catheterization laboratory practices, availability of dedicated equipment to seal CAP, perform pericardiocentesis, and provide hemodynamic support, as well as adequate training, are pillars for the prevention and optimal management of CAP during CTO PCI.

Original languageEnglish (US)
Pages (from-to)71-87
Number of pages17
JournalExpert Review of Cardiovascular Therapy
Volume19
Issue number1
DOIs
StatePublished - 2021

Keywords

  • Cardiac tamponade
  • chronic total occlusion
  • coil
  • complications
  • coronary artery perforation
  • covered stent
  • embolization
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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